The straight dope on Italian health and medical care, from an American woman doctor who lives and works in Rome. Her memoir, Dottoressa, will be published in May 2019.

Monday, December 24, 2018

My Life As an LMD

drawing by Suzanne Dunaway

Italian public hospital
doctors tend to despise general practitioners, resent private physicians, and defend
their realm from both. One time a patient came to my office in obvious need of
immediate abdominal surgery. I shipped him off to the Emergency Room with a
referral letter, heard from the family that some kind of operation had been
done, tracked down the surgeon on the phone – and the guy refused to tell me
what he found.

During my residency in New York City
hospitals our attitude wasn’t much different. Our self-importance was reflected
in the sneering phrases we used to refer to outsiders. “Saint Elsewhere” was
resident slang for a humbler hospital that had, in our opinion, mishandled a difficult
patient and then punted him or her over to our training institution for us to
patch up (New York hospitals’ saints included Anthony, Barnabas, Clare,
Elizabeth, Giles, Joseph, Luke, Mary, Vincent, and a whole host of Johns).

“LMD,” short for “local medical
doctor,” referred archly to a patient’s outside physician, always presumed to
be an idiot. A typical emergency room medical history: “3 days ago 105º fever
and difficulty breathing. LMD prescribed aspirin over the phone.”

Being on the other side of the divide,
now that I’m an LMD myself, isn’t easy. When I’m trying to get an update on a
patient of mine who’s been admitted to one of Rome’s public hospitals, I do
everything to avoid the categories of either competitor or smarty pants. The
best results come if I have a friendly colleague who works in the hospital go and
spy. When there’s no inside informant for me to turn to, I’ll make diplomatic phone
calls attempting to cajole the hospital docs into giving me information, on
grounds ranging from the patient’s embassy has asked to be informed, to the
relatives are pestering me from the States, to the patient doesn’t speak a word
of Italian. Whatever I can think of.

This can lead to dangerous
pussyfooting around which at least once, back in the ‘90s, led to dire
consequences. I gave in to the pleas of the worried wife of one American
tourist, who was in the Santo Spirito Hospital’s intensive care unit for chest
pain, and agreed against my better judgment to make a trip to the hospital to
take a look. Once there I played super-nice with the house physicians to avoid
offense: I merely glanced at the blood test results, I read the x-ray reports without
looking at the actual films, and I listened respectfully to the staff’s reassuring
conclusions. I backed the hospital docs up all the way, and told the patient’s
wife that since he hadn’t had a heart attack he'd surely be able to fly home in
a couple of days.

Well, that patient died ten hours later,
of a ruptured aortic aneurysm, when a segment of the body’s main artery has
ballooned out as it exits the heart, and bursts. This is a major emergency that
can often be diagnosed or at least suspected from a simple chest x-ray, and
could have been cured by surgery. I was devastated. When a fit of masochism
sent me back to the hospital the next day to take a look at the x-ray I had
skipped on my previous trip, the diagnosis seemed obvious. But without knowing
the answer ahead of time would I have gotten it right just by looking at the
film? Was the patient’s death chiefly the fault of the hospital doctors’ failure
to make the diagnosis, or was it my own fault for the insecurities that had
made me suck up to the hospital staff and the family rather than be thorough?
Writing about it now 20 years later I still shudder with guilt.

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About Me

I moved to Rome in 1978 after finishing my training in New York, and have been practicing primary care internal medicine there ever since, treating a clientele that’s featured Roman auto mechanics and British ambassadors, Indonesian art restorers and Filipina maids, Russian poets and Ethiopian priests. When not seeing patients, doing research in psychosomatic medicine, or being the Artist's Wife to my composer husband, I've written a book about my medical adventures, Dottoressa: An American Doctor In Rome, to be published by Paul Dry Books in May 2019.